Abstract The authors report the case of a 71-year-old woman presented to the Emergency Department with acute ischemic stroke. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma. Angioedema after rt-PA infusion could be a life-threatening emergency that requires quick airway management by skilled professionals. As this condition is triggered by several factors, such as unregulated histamine and bradykinin production, the traditional treatment recommended by the guidelines may not be sufficient and the use of FFP can be considered as a safe and valuable aid. 71yearold yearold 71 year old stroke rtPA rt PA intubation plasma lifethreatening life threatening professionals factors production aid 7

ABSTRACT Microsporum gypseum is a geophilic fungus that can cause inflammatory skin lesions in heathy people. More extensive lesions have been described in immunocompromised patients. We present a patient with extensive dermatophytosis, which mycological examination led the identification of Candida sp, Epidermophyton Floccosum and Trichophyton tonsurans and showed poor response to treatment with griseofulvina and itraconazol at usual doses. When skin biopsy was performed, it had positive culture for M. gypseum. Due to the extension and poor response to treatment, immunological assessment was performed and it showed a defect of STAT1 with gain of function (STAT 1-GOF). Patients with primary immunodeficiency are susceptible to fungal infections, especially Candida but also virus and bacteria, although to a lesser extent. The patient received long-term treatment with systemic imidazole antifungal recovering for the lesions.

RESUMEN El Microsporum gypseum es un hongo geofílico que puede producir lesiones cutáneas inflamatorias en personas sanas. Se han descripto lesiones más extensas en pacientes inmunocomprometidos. Se presenta el caso de un paciente con dermatofitosis, con exámenes micológicos positivos para Candida sp, Epidermophytom floccosum y Trichophyton tonsurans, al que, ante la mala respuesta al tratamiento con griseofulvina e itraconazol a dosis habituales, se le realizó biopsia cutánea para cultivo que evidenció la presencia de M. gypseum. Debido a la extensión y a la mala respuesta al tratamiento, se realizó evaluación inmunológica y se diagnosticó un defecto en STAT1 con ganancia de función (STAT1-GOF). Los pacientes que tienen esta inmunodeficiencia primaria son susceptibles a las infecciones micóticas, especialmente por Candida, pero también, aunque en menor medida, a virus y bacterias. El paciente aquí presentado recibió tratamiento prolongado con antimicóticos imidazólicos sistémicos, con resolución de las lesiones.

Background: Enteral nutrition therapy can be provided using comercialized products (chemically defined formulas) or blenderized home-made preparations. Objective: To perform an integrative review of the literature comparing the use of both type of formulation. Methods: In this descriptive study papers published in English, Spanish or Portuguese Brazil, in journals indexed in the databases PubMed, EMBASE, Scopus, Web of Science and Bireme without the period 2010 to 2015 were reviewed The terms "enteral nutrition, foods, formulated, diet, homemade diet industrial and artisanal diet" according to the MeSH were used for the search. Results: Twelve articles were selected. Most studies showed a level 4 of evidence and were published in journal in the higher Qualis index. Four aspects were evaluated: comparison between groups studying the clinical effects; comparison of the chemical composition of home-made products; physical-chemical and microbiological analysis of the enteral diets comes; articles on epidemiological Data on home enteral nutrition Conclusion: Industrialized diet is more suitable for patients using alternative feeding supply at home. But it has a higher cost.

Introducción: en la terapia nutricional enteral pueden administrarse productos comerciales con fórmulas químicamente definidas o preparados artesanales compuestas por alimentos naturales y/o procesados. Objetivo: realizar una revisión integradora de la literatura sobre el uso de la dieta artesanal versus industrializada, en pacientes con nutrición enteral. Métodos: estudio descriptivo de los artículos originales que comparaban el uso de fórmulas enterales comerciales con preparados caseros. Se consideraron elegibles los artículos publicados en inglés, español o portugués, en revistas indexadas en las bases de datos: PubMed, Scopus, EMBASE, Web of Science y Bireme en el periodo de 2010 a 2015, a partir de los descriptores: "enteral nutrition, food, formulated, industrialized diet, homemade diet, handmade diet". Para el análisis de los estudios fue utilizado un instrumento específico para evaluación de artículos. Resultados: finalmente se analizaron 12 artículos. La mayoría de los estudios presentó un nivel de evidencia 4 y fueron publicados en revistas de elevado índice Qualis. Los artículos fueron separados en 4 grupos: comparación del uso de las dietas y el efecto en los pacientes que las recibían; evaluación de la composición química de la alimentación enteral artesanal por medio de tablas de composición de alimentos; análisis físico-químico y microbiológico de las dietas enterales artesanales; y artículos que presentaron la situación epidemiológica de la terapia nutricional enteral domiciliaria. Conclusión: la dieta industrializada es la más indicada para pacientes que nutrición enteral en el domicilio, mientras, que los costos generados pueden volverse grandes obstáculos para quien la elija.

A neuralgia clássica do trigêmio (NTC) é tratada predominantemente por drogas, porém efeitos colaterais e falhas terapêuticas ocorrem. Avaliamos o efeito terapêutico da combinação entre farmacoterapia e bloqueio analgésico utilizando a lidocaína. Treze pacientes portadores de NTC tratados com farmacoterapia foram divididos em dois grupos: Grupo I pacientes que mantiveram somente tratamento medicamentos e Grupo II pacientes que associaram bloqueio anestésico. O objetivo primário do estudo foi à redução da freqüência da dor 30 e 90 dias após o bloqueio. Secundariamente avaliamos o impacto sobre as escalas de depressão, dor e qualidade de vida. O grupo II teve uma redução significativa na freqüência da dor e uma melhora nos escores de qualidade de vida, dor e escala de depressão. Os resultados sugerem um benefício clinico da combinação de farmacoterapia e bloqueio anestésico no tratamento da NTC.

Classical trigeminal neuralgia (CTN) is treated predominantly by pharmacotherapy but side effects and unsuccessful occurs. The current study was carried out to evaluate the therapeutic effect of combination of pharmacotherapy and lidocaine block. Thirteen patients with CTN managed with pharmacotherapy were recruited and assigned either to no additional treatment (Group I) or to additional analgesic block (Group II). The primary endpoint was the reduction in the frequency of pain episodes in a month assessed at 30 and 90 days. Comparisons of measurements of pain, general health and depression scales were secondary endpoints. The results from the follow-up visits at 30 and 90 days showed the Group II to have larger reduction in the frequency of pain and exhibited a bigger improvement in the scores of the pain, general health and depression scales. The results from this preliminary study suggest a clinical benefit of the combination of pharmacotherapy and lidocaine block.

The objective of this paper is to investigate mortality among 1247 male asbestos-cement workers employed in an asbestos-cement plant located in Naples. The cohort included 1247 men hired between 1950 and 1986. The follow-up began on January 1st 1965. The vital status and causes of death were ascertained up to December 31 2005. Cause-specific mortality rates of the Campania Region population were used as reference. Relative risks were estimated using Standardized Mortality Ratios (SMRs), and the confidence intervals were calculated at a 95% level (95% CI). A significant increase in mortality was observed for respiratory disease (81 deaths; SMR = 187; 95% CI = 149-233), particularly for pneumoconiosis (42 deaths; SMR = 13 313; 95% CI = 9595-17 996) of which 41 deaths for asbestosis (SMR = 43 385; 95% CI = 31 134-58 857), for pleural cancer (24 deaths; SMR = 2617; 95% CI = 1677-3893), for lung cancer (84 deaths; SMR=153; 95% CI = 122-189) and for peritoneal cancer (9 deaths; SMR = 1985; 95% CI = 908-3769). Non-significant increases were also observed for rectum cancer (6 deaths; SMR = 157; 95% CI = 58-342). In conclusion, consistently with other mortality studies on asbestos-cement workers performed in different countries, an increased mortality from asbestosis, lung cancer, pleural and peritoneal mesothelioma was detected in the present cohort.

Obiettivo del presente studio è descrivere la mortalità di una coorte di 1247 lavoratori della Eternit di Bagnoli (NA). è stato condotto uno studio di coorte, ristretto agli uomini, che ha incluso 1247 soggetti assunti a partire dal 1950 sino al 1986, con follow up iniziato nel 1965. Lo stato in vita e le cause di morte sono state accertate al 31/12/2005. La mortalità osservata è stata confrontata con quella attesa in base ai tassi di riferimento della popolazione campana. Sono stati calcolati i rapporti di mortalità standardizzati (SMR) per il periodo 1965-2005 ed i corrispondenti intervalli di confidenza al 95% (IC 95%). Un incremento significativo della mortalità è stato osservato per le malattie respiratorie (81 deceduti; SMR = 187; IC 95% = 149-233), in particolare per le pneumoconiosi (42 deceduti; SMR = 13313; IC 95% = 9595-17996; dei quali 41 deceduti per asbestosi; SMR = 43385; IC 95% = 31134-58857), per tumore maligno della pleura (24 decessi; SMR = 2617; IC 95% = 1677-3893), per tumore del polmone (84 decessi; SMR = 153; IC 95% = 122-189) e per tumore maligno del peritoneo (9 decessi; SMR = 1985; IC 95% = 908-3769). Un incremento non statisticamente significativo è stato osservato per il tumore del retto (6 decessi; SMR = 157; IC 95% = 58-342). In conclusione, i risultati del presente studio, coerentemente con l'insieme dell'evidenza epidemiologica relativa agli effetti sulla salute dell'esposizione a cemento-amianto, mostrano un'aumentata mortalità per asbestosi, cancro polmonare, mesotelioma pleurico e peritoneale.

Coffee berry borer Hypothenemus hampei (Ferrari) was informed in Cuba in 1995 and nowadays it is present in most of the producing areas along the country. In this way the search of alternatives for its management has not ceased from their introduction and at the present time there is a group of them of feasible use. Among these methods the use of rustic traps has an outstanding place because it is a simple and economic option. However the more effective alcoholic attractive for the adults capture had not been determined in Cuban conditions. In this sense a work was realized with the objective of evaluating the effectiveness of ethyl alcohol from sugar cane alone and mixed with methyl alcohol and roast grinded coffee, as attractive for the coffee berry borer. The experiment was carried out in pre harvesting phase of a coffee plantation in Pinar del Río province, in the west part of the country. Significant differences were proven among the three treatments. The best capture values were detected with the mixture of methyl alcohol+ethyl alcohol in the proportion 3:1, and lowest values were recorded when the alone ethylic alcohol was used. The feasibility of using ethyl alcohol of sugar cane as attractive of H. hampei was demonstrated and two tendencies in the behaviour of captures in time according to treatment were observed.

La broca del café Hypothenemus hampei (Ferrari) fue informada en Cuba en 1995, y hoy está presente en la mayoría de las áreas productoras del país; de ahí que la búsqueda de alternativas para su manejo no ha cesado hasta disponer en la actualidad de un grupo de ellas de factible utilización, entre las que se destaca el uso de trampas rústicas por ser una opción sencilla y barata. A pesar de esto, no se había determinado el atrayente alcohólico más efectivo en la captura de adultos bajo las condiciones del país. En este sentido se realizó un trabajo con el objetivo de evaluar la efectividad del alcohol etílico de caña de azúcar como atrayente de la broca del café solo y en mezclas con alcohol metílico y café tostado molido. El experimento se realizó en la etapa de precosecha en un cafetal de la provincia de Pinar del Río, en el occidente del país. Se comprobaron diferencias significativas entre los tres tratamientos, con los mejores valores de captura para la mezcla de metanol + etanol 3:1, y los valores más bajos se registraron cuando se utilizó el alcohol etílico solo. Se demostró la factibilidad de utilizar alcohol etílico de caña de azúcar como atrayente de brocas y se observaron dos tendencias en el comportamiento de las capturas en el tiempo según el tratamiento.

The conservation of coffee berry borer (Hypothenemus hampei Ferrari) natural enemies has great importance for Cuban coffee plantations; in this way a study of ants predators was carried out in the Empresa Cafetalera Bahía Honda, in Pinar del Río province during the crop of 2006, monthly evaluation was realized in six coffee plantations located to 200 meters some of other, with different soil and shade management. Ants was sampling in three vertical strata by means of trapping stations. In the own plants the index of coffee berry borer infestation was evaluated in each one of three productive branches by level. There were captured 1473 individuals of five ants species: Wasmannia auropunctata (Roger), Solenopsis geminata (Fabricius), Tetramorium bicarinatum (Nylander), Monomorium floricola (Jerdon) and Pheidole megacephala (Fabricius), the most abundant species was W. auropunctata. A bigger diversity of ants was observed in the order of preference floor>stem>bearing; traditional field type with forest trees, wrap pruning and cocoa tree trash reached the biggest diversity in the three studied strata. A narrow relationship was observed among the fields of smaller H. hampei infestation index and those of more antsspecies diversity, where T. bicarinatum and S. geminata prevailed, this suggests the necessity to continue the study of ants potentialities as biological controllers.

La conservación de los enemigos naturales de la broca del café (Hypothenemus hampei Ferrari) tiene gran importancia para los cafetales de Cuba. Al respecto se realizó el estudio de hormigas predadoras en la empresa cafetalera de Bahía Honda en la provincia de Pinar del Río, durante la cosecha del 2006, mediante una evaluación mensual en seis cafetales ubicados a 200 m unos de otros, con diferentes manejos del suelo y la sombra. Las hormigas se muestrearon en tres estratos verticales por medio de estaciones de trampeo. En las propias plantas se evaluó el índice de infestación de la broca del café en cada una de tres ramas productivas por nivel. Se capturaron 1473 individuos de cinco especies de hormigas: Wasmannia auropunctata (Roger), Solenopsis geminata (Fabricius), Tetramorium bicarinatum (Nylander), Monomorium floricola (Jerdon) y Pheidole megacephala (Fabricius). La especie más abundante fue W. auropunctata. Se advirtió una mayor diversidad de hormigas en el orden de preferencia suelo>tallo>cojinete. El campo tradicional a base de árboles forestales, arrope de poda y hojarasca del cacaotero alcanzó la mayor diversidad en los tres estratos estudiados. Se observó una estrecha relación entre los campos de menor índice de infestación por H. hampei y los de mayor diversidad de especies de hormigas, donde predominaban T. bicarinatum y S. geminata. Esto sugiere la necesidad de continuar el estudio de las potencialidades de las hormigas como controladores biológicos.

This retrospective and documental study characterizes the profile and identifies the expectations of nurses entering the cardiovascular nursing improvement course-residency modality from 1980 to 2004. Data was collected in 2005 at a public cardiology institution in São Paulo, SP, Brazil, from 161 students' admission records. As to the students' profile, most had just received their degree in Nursing, 58% ranged from 21 to 23 years of age, 95% were females, 72% came from São Paulo, and 82% were scholarship holders. Results on their expectations expressed their concern with acquiring and improving knowledge and practice in cardiology and SAE (Nursing Assistance Systematization) on the one hand and, on the other hand, with professional growth and with the achievement of better employment conditions, that is, with opening up doors to the job market. Conclusions show that those expectations meet the goals set up in the pedagogic proposal for the development of the nurses' professional competences concerning assistance, learning, research, and management, all of which preparing them for their active professional life.

Este estudio retrospectivo y documental tuvo como objetivo caracterizar el perfil e identificar las expectativas de los enfermeros ingresantes en el Curso de Especialización en Enfermeria Cardiovascular en la modalidad de Residencia, entre 1980 y 2004. Fue realizado en institución pública y de referencia en cardiología en el Estado de São Paulo Brasil. Los datos fueron recolectados en 2005, a partir de documentos obtenidos en la admisión de 161 alumnos. Cuanto al perfil, la mayoria era enfermero recién graduado, edad entre 21 y 23 años (58%), sexo femenino (95%), procedentes de São Paulo (72%) y recibia bolsa de estudios (82%). Respecto a las expectativas en relación al curso: adquirir y mejorar conocimientos y práctica en cardiología y en la sistematización de la asistencia de enfermeria; la posibilidad de crecer profesionalmente y obtener un mejor mercado laboral. Se concluye que esas expectativas en relación al curso concuerdan con las finalidades determinadas en la propuesta pedagógica para el desarrollo de competencias profesionales del enfermero para el saber, el aprender y el actuar en asistencia, enseñanza, investigación y gestión, preparándolo para el mundo del trabajo.

Este estudo retrospectivo e documental objetivou caracterizar o perfil e identificar as expectativas dos enfermeiros ingressantes no Curso de Aprimoramento em Enfermagem Cardiovascular modalidade Residência, entre 1980 e 2004. Foi realizado em instituição pública cardiológica de São Paulo, em 2005, coletando-se os dados dos documentos admissionais dos 161 alunos. Quanto ao perfil, a maioria era enfermeiro recém-graduado, idade entre 21 e 23 anos (58%), sexo feminino (95%), procedente de São Paulo (72%) e bolsista (82%). Quanto às expectativas em relação ao Curso, identificou-se o adquirir e aprimorar conhecimentos e prática na cardiologia e na sistematização da assistência de enfermagem, a possibilidade de crescer profissionalmente e ter melhores condições de empregabilidade ou abrir portas para o mercado de trabalho. Assim, as expectativas vão ao encontro das finalidades determinadas na proposta pedagógica de desenvolvimento de competências profissionais do enfermeiro para o saber, aprender e agir na assistência, ensino, pesquisa e gestão, preparando-o para o mundo do trabalho.

OBJETIVOS: Avaliar a concentração de flúor na água de abastecimento público e a prevalência de fluorose dentária de escolares entre 7 e 15 anos de idade, residentes em um bairro da periferia de Bauru. MATÉRIAL E MÉTODOS: Foram coletadas 52 amostras de água durante três dias de uma semana e analisadas utilizando-se o eletrodo íon sensível (Orion 9609), acoplado a um potenciômetro (Procyon, modelo 720), com 1,0 mL da amostra à qual foi adicionado 1,0 mL de TISAB II (Orion). Para o levantamento epidemiológico de fluorose foram examinados 52 escolares entre 7 e 15 anos de idade, de ambos os gêneros, mediante a obtenção de autorização prévia dos responsáveis. Somente um examinador realizou os exames após escovação supervisionada e secagem dos dentes com rolos de algodão. O índice utilizado foi o TF, estabelecido a partir do grau máximo verificado em cada indivíduo. RESULTADOS: A concentração de flúor na água variou entre 0,62 e 1,15 mg/L, mantendo uma média de 0,9 mg/L. A prevalência de fluorose dentária verificada foi de 33%, com severidade variando entre TF1 e TF4 (Kappa=0,73 e concordância de 83,33%). CONCLUSÕES: Os resultados da análise das amostras de água indicam uma concentração média de flúor acima do recomendado para Bauru. O índice de fluorose dentária verificado foi maior que o esperado para um bairro da periferia, onde a água é uma das poucas fontes de ingestão de flúor.

OBJECTIVES: The objectives of this study were to assess the fluoride concentration in the public water supply and the prevalence of dental fluorosis in schoolchildren between 7 and 15 years old, living in a peripheral district of the municipality of Bauru. MATERIAL AND METHODS: For this, fifty two water samples were collected on three different days of one week. These samples were analyzed for fluoride by means of the ion-sensitive electrode method (Orion 9609) coupled to a potentiometer (Procyon, model 720). In this method, 1.0 mL of TISAB II (Orion) was added to 1.0 mL of the sample. For the epidemiological survey of fluorosis, 52 schoolchildren of both genders, aged between 7 and 15 were assessed, with prior authorization from their caretakers. Only one person examined the children, after supervised toothbrushing and drying with cotton wool rolls. The TF index was used. RESULTS: The fluoride concentrations in the water samples ranged from 0.62 to 1.20 mg/L, with a mean of 0.9 mg/L. The prevalence of dental fluorosis was 33%, with severity ranging from TF1 to TF4 (Kappa of 0.73 and concordance of 83.33%). CONCLUSIONS: The results from the analysis of water samples indicated a fluoride concentration greater than recommended for Bauru. The fluorosis levels found were higher than expected for a peripheral district, in which water is one of the few sources of fluoride.